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1. Senior Block- O&G > STIs and PID > Flashcards

STIs and PID Flashcards

1
Q

What type of epithelial cells are found in the prepubertal genital tract?

A

Simple cuboidal

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2
Q

What type of epithelial cells are found in the pubertal genital tract?

A

Stratified squamous

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3
Q

What type of epithelial cells are found in the postmenopausal genital tract?

A

Atrophic changes to stratified squamous cells

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4
Q

What type of bacteria are found in the prepubertal genital tract?

A

Similar to skin commensals

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5
Q

What type of bacteria are found in the pubertal genital tract?

A

Lactobacilli dominant

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6
Q

What type of bacteria are found in the postmenopausal genital tract?

A

Similar to skin commensals

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7
Q

What is the pH of the prepubertal genital tract?

A

Alkaline

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8
Q

What is the pH of the pubertal genital tract?

A

3.5 to 4.5

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9
Q

What is the pH of the postmenopausal genital tract?

A

Alkaline

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10
Q

Give 4 predisposing factors for bacterial vaginosis

A 
Sexually active
Change of partner
IUD
Vaginal douching 
Smoking
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11
Q

What is the pathophysiology of bacterial vaginosis?

A

Decrease in lactobacilli and increase of anaerobic and BV associated bacteria in the vagina.
Proteolytic enzymes break down vaginal peptides into amines and the pH rises to favour Gardnerella Vaginalis

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12
Q

Give the 2 main clinical features of bacterial vaginosis

A

Grey-white discharge

Fishy smell

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13
Q

How is Bacterial Vaginosis investigated?

A

Increased vaginal pH
KOH ‘wiff’ test –> strong odour when KOH added to discharge
High vaginal smear microscopy- can see Clue cells and decrease in lactobacilli

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14
Q

How is Bacterial Vaginosis managed?

A

Metronidazole oral/topical

Or Clindamycin cream

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15
Q

What are the effects of BV when pregnant?

A

Increased risk of premature birth
Miscarriage
Chorioamnionitis

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16
Q

Give 4 predisposing factors for Thrush development

A 
Pregnancy 
Diabetes
Broad-spectrum Antibiotics
Corticosteroid use
Immunosuppression
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17
Q

What is the pathophysiology of a Thrush infection?

A

Candida Albicans is a yeast like fungus which exploits opportunities such as a weakened host.

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18
Q

Give 3 clinical features of Thrush

A

Vaginal itching
Vaginal discharge- white, thick, non-smelling
Dysuria
Erythema of vulva

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19
Q

How is Thrush investigated?

A

Vaginal pH
Vaginal smear
Microscopy

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20
Q

How is Thrush managed?

A 
Clotrimazole pessary
Oral fluconazole (not in pregnant)
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21
Q

Give 2 predisposing factors for chlamydia infection

A

<25 years old
Many sexual partners
Recent change in partner
Infrequent use of barrier contraception

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22
Q

Which bacteria causes chlamydia?

A

Chlamydia trachomatis (Gram neg)

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23
Q

How is chlamydia transmitted?

A

Sexual intercouse

Skin to skin contact of genitals

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24
Q

When chlamydia is symptomatic what symptoms may men and women experience?

A

Women= dysuria, vaginal discharge, post-coital bleeding, deep dyspareunia, lower abdominal pain

Men= urethritis, urethral discharge, dysuria, testicular pain

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25
Q

How is chlamydia diagnosed in men and women?

A

Nucleic acid amplification test (NAAT)

Women= vulvovaginal swab, endocervical swab, first catch urine sample

Men= first catch urine sample, urethral swab

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26
Q

What medications are given to treat chlamydia?

A

Doxycycline 100mg BD for 7 days

Azithromycin 1g single dose

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27
Q

What advice would you give to a patient with chlamydia?

A

Avoid sex until the treatment is finished
Contact tracing
Full STI screen

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28
Q

Give 3 predisposing factors for Gonorrhoea infection

A 
<25 years old
Men who have sex with men
Living in cities
PHx of gonorrhoea infection
Multiple partners
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29
Q

How is Gonorrhoea transmitted?

A

Sexual intercourse

Vertically from mother to child

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30
Q

What bacteria causes Gonorrhoea?

A

Neisseria gonorrhoeae

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31
Q

What is the pathophysiology of Gonorrhoea?

A

Bacteria has a strong affinity for mucous membranes. It adheres and invades the host cells to cause inflammation. The surface proteins prevent an immune response from occurring

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32
Q

When Gonorrhoea is symptomatic, what symptoms may be experienced?

A

Vaginal discharge (thin, watery, green/yellow)
Dysuria
Dyspareunia
Lower abdominal pain
Rectal infection= anal discharge and discomfort

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33
Q

How is Gonorrhoea diagnosed in men and women?

A

Women=
Endocervical/vaginal swab- NAAT
Endocervical/urethral swab- microscopy and culture

Men=
First pass urine- NAAT
Urethral/meatal swab- microscopy and culture

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34
Q

How is Gonorrhoea treated medically?

A

IM ceftriaxone 500mg

Oral azithromycin 1g- covers any concurrent chlamydia

35
Q

What other advice would you give to a patient with Gonorrhoea?

A

Screen for other STIs
Contact tracing
Follow up to check treatment has worked

36
Q

Give 2 potential complications of Gonorrhoea

A

PID

Males= epididymo-orchitis, prostatitis

37
Q

How can Gonorrhoea when pregnant, affect the pregnancy?

A

Increased risk of spontaneous abortion
Premature labour
Early fetal membrane rupture
Gonococcal conjunctivitis of the neonate

38
Q

What are the potential complications of a Chlamydia infection?

A

PID
Reactive arthritis
Can spread to eyes

39
Q

How can chlamydia when pregnant, affect the pregnancy?

A

Increased risk of premature delivery
Increased risk of miscarriage and stillbirth
Neonatal chlamydial conjunctivitis

40
Q

Give 3 predisposing factors for Genital Warts (HPV)

A 
Early age of 1st sexual intercourse
Multiple partners
Immunosuppression 
Smoking 
Diabetes
41
Q

What is the pathophysiology of Genital HPV?

A

HPV penetrates the epithelial barrier and infects basal keratinocytes. It replicates inside the keratinocytes causing lesions.

Spread via skin to skin contact

42
Q

Which forms of HPV are oncogenic?

A

16 and 18

Cause precancerous skin changes

43
Q

What are the clinical features of HPV genital warts?

A

Painless, fleshy growths which can be soft or hard

Found on the penis, scrotum, vulva, vagina, cervix, perianal skin or inside anus

44
Q

How are HPV warts managed?

A

Can resolve spontaneously

Topical treatments= podophyllotoxin, Imiquimod

Physical ablation= excision, cryotherapy, electrosurgery, laser surgery

45
Q

Give 2 predisposing factors for Genital Herpes

A

Multiple sexual partners

Oral sex from a partner with cold sores

46
Q

What is the pathophysiology of Genital Herpes?

A

HSV enters the body through small cracks in the skin and mucous membranes.
Travels to nearest nerve ganglion and remains dormant.
When reactivated it travels down the nerve to the skin and causes symptoms

47
Q

What are the symptoms of a genital Herpes lesion?

A

Small red blisters which are painful
Vaginal or penile discharge
Itching

48
Q

How is Genital Herpes managed?

A

Antiviral- Acyclovir
Painkillers
Petroleum jelly
Ice packs

49
Q

If a mother has HPV before becoming pregnant, how is the pregnancy managed?

A

Will pass on antibodies to baby. Can take Aciclovir. Can have vaginal birth

50
Q

If a mother has HPV in T3 of pregnancy, how is the pregnancy managed?

A

Does not have antibodies to pass on

40% chance of vertical transmission in vaginal birth so C-section recommended

51
Q

Give 3 predisposing factors for syphilis

A

Unprotected sex
Multiple sexual partners
MSM
HIV infection

52
Q

What is the pathophysiology of syphilis?

A

Caused by Gram negative bacterium Treponema pallidum subspecies pallidum. Spread via sex or mother to fetus

Enters through break in the skin or mucous membranes. Bacteria divides and forms an infectious hard ulcer.

If left untreated can cause systemic damage via obliterating arteritis. The endothelial cells of vessels proliferate and cause the lumens to narrow leading to ischaemia of the tissues.

53
Q

What are the symptoms of primary syphilis?

A

Chancre appears on penis, scrotum, anus, rectum, labia or cervix

Hard painless ulcer which heals in 3-10 weeks

54
Q

What are the symptoms of secondary syphilis?

A 
Skin rash on hands
Fever
Malaise
Arthralgia
Weight loss
Headaches
Lymphadenopathy
Grey mucus membranes 
Condylomata lata (plaques on the skin)
55
Q

What are the symptoms of tertiary syphilis?

A

Many years after initial infection

Neurosyphilis- dementia, CN palsies, stroke, Argyll-Robertson pupil, tabes dorsalis

Cardiovascular- aortic regurgitation, angina, calcification of AA, aortic root dilation

Gummatous- granuloma formation

56
Q

How is syphilis investigated?

A

Dark ground microscopy of chancre fluid
PCR of active lesion swab
Serology
Lumbar puncture

57
Q

How is syphilis managed?

A

Early- Benzathine penicillin 2.4MU IM single dose
Late- Benzathine penicillin 2.4MU IM 3 doses at weekly intervals

Neurosyphilis- procaine penicillin IM OD for 14 days + probenecid 500mg PO QDS for 14 days

58
Q

How can syphilis affect a pregnancy?

A

Antenatal screening at 1st appointment

Infect baby at delivery
Increased risk of miscarriage, stillbirth, preterm labour, congenital syphilis.

59
Q

Give 2 predisposing factors for HIV

A

Men who have sex with men
IV drug users
Unprotected sex with someone from a high incidence area eg. Africa

60
Q

What is the pathophysiology of HIV infection

A

Single stranded RNA retrovirus enters CD4 cell and releases its contents. RNA converted to DNA in the cell and is combined with the cell’s DNA. The DNA and virus is replicated by the cell to form viral protein chains.

Protease enzyme cuts viral chain to form a mature virus. CD4 cell destroyed in the process. Drop in CD4 cell number causes drop in immune function.

61
Q

What is AIDS?

A

Very low CD4 count, high viral load

AIDs defining illness - eg. TB, non-Hodgkin lymphoma, pneumocystis jiroveci pneumonia

62
Q

Give 4 clinical features of the seroconversion illness experienced 2-6 weeks after HIV infection

A 
Malaise
Headache
Fever
Weight loss
Mouth sores
Oral thrush 
Pharyngitis
Myalgia
Hepatomegaly 
Lymphadenopathy 
Oesophageal sores
N+V
Splenomegaly
63
Q

Give 3 clinical features of symptomatic HIV after the latent phase

A

Weight loss
Fever
Diarrhoea
Minor opportunistic infections- cold sores, thrush

64
Q

How is HIV diagnosed?

A

ELISA testing for serum HIV antibodies + p24 antigen

65
Q

How is HIV managed?

A

HAART- reduces viral load to undetectable levels. Very good prognosis

Target individual enzymes- NRTIs, PIs, NNRTIs, InSTIs

Manage psychological impact

66
Q

What tests are used to monitor HIV?

A

CD4, viral load, FBC, U+Es, Urinalysis, ALT, AST, bilirubin

67
Q

When is post-exposure prophylaxis (PEP) taken for HIV?

A

If suspected to be exposed to HIV in the past 72 hours. Take PEP to lower risk of being infected. Take for 1 month

68
Q

In a mother with HIV what advice would you give her about her pregnancy and after?

A

HIV can be transmitted in pregnancy and through breastfeeding. With treatment risk is <1%

Antenatal antiretroviral therapy
Do not breastfeed
Neonatal post-exposure prophylaxis

69
Q

Give 3 predisposing factors for trichomonas vaginalis

A

Multiple partners
Unprotected sex
Hx of other STIs
Older woman

70
Q

What microorganism causes trichomonas vaginalis?

A

Anaerobic flagellated protozoan, Trichomonas Vaginalis

71
Q

How is Trichomonas Vaginalis spread?

A

Unprotected vaginal sex

72
Q

What is the pathophysiology of Trichomonas Vaginalis?

A

Replicates via binary fission and destroys epithelial cells through direct cell contact by release of cytotoxins

73
Q

What are the clinical features of Trichomonas Vaginalis in men and women?

A

Women= offensive vaginal odour, abnormal vaginal discharge, itchy vulva, dyspareunia, dysuria

Men= urethral discharge, dysuria, urinary frequency, pain and itching around foreskin

74
Q

How is Trichomonas Vaginalis diagnosed in men and women?

A

Women= high vaginal swab

Men= urethral swab or 1st void urine

Full STI screen

75
Q

How is Trichomonas Vaginalis managed?

A

Metronidazole- 2g orally in one dose or 400mg BD for 5-7 days

Contact tracing

76
Q

What risks are increased if there is Trichomonas Vaginalis in pregnancy?

A

Risk of premature labour
Risk of low birth weight
Predisposed to maternal postpartum sepsis

77
Q

Give 5 predisposing factors for Pelvic Inflammatory Disease

A 
15-24 years old 
Sexually active
Hx of STIs
Recent IUD fitted 
Recent TOP
Recent partner change 
Unprotected sex
Hx of previous PID 
Recent gynae surgery
78
Q

What is the pathophysiology of Pelvic Inflammatory Disease?

A

Spread of vaginal or cervical infection up into the endometrium, uterus, fallopian tubes, ovaries and peritoneum.

Due to Chlamydia trachomatis, Neisseria Gonorrhoea, Streptococcus, Bacteroides and Anaerobes.

79
Q

Give 4 clinical features of Pelvic Inflammatory Disease

A 
Lower abdominal pain 
Deep dyspareunia
Post-coital bleeding 
Menstrual abnormalities
Abnormal vaginal discharge 
Dysuria 
Fever
N+V
80
Q

How is Pelvic Inflammatory Disease diagnosed?

A

Endocervical + high vaginal swabs for NAAT
Full STI screen
Urine dip + MSU- exclude UTI
Pregnancy test

If unsure:
TV USS
Laparoscopy

81
Q

How is Pelvic Inflammatory Disease managed?

A

14 days of broad spectrum antibiotics
Doxycycline, Ceftriaxone, Metronidazole
OR Ofloxacin + Metronidazole

Analgesia
Rest
Contact tracing

82
Q

When should a patient with Pelvic Inflammatory Disease be admitted to hospital?

A 
Pregnant
Severe symptoms 
Signs of peritonitis 
Unresponsive to antibiotics
Need emergency surgery
83
Q

Give 3 complications of Pelvic Inflammatory Disease

A 
Ectopic pregnancy 
Infertility- 1 in 10 women
Tubo-ovarian abscess
Chronic pelvic pain 
Fitz-Hugh-Curtis syndrome- perihepatitis causing RUQ pain

1. Senior Block- O&G (11 decks)

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